A health impact assessment of gender inequities associated with psychological distress during COVID19 in Australia’s most locked down state—Victoria

Background Since March 2020, when the COVID19 pandemic hit Australia, Victoria has been in lockdown six times for 264 days, making it the world’s longest cumulative locked-down city. This Health Impact Assessment evaluated gender disparities, especially women’s mental health, represented by increased levels of psychological distress during the lockdowns. Methods A desk-based, retrospective Health Impact Assessment was undertaken to explore the health impacts of the lockdown public health directive with an equity focus, on the Victorian population, through reviewing available qualitative and quantitative published studies and grey literature. Results Findings from the assessment suggest the lockdown policies generated and perpetuated avoidable inequities harming mental health demonstrated through increased psychological distress, particularly for women, through psychosocial determinants. Conclusion Ongoing research is needed to elucidate these inequities further. Governments implementing policies to suppress and mitigate COVID19 need to consider how to reduce harmful consequences of these strategies to avoid further generating inequities towards vulnerable groups within the population and increasing inequalities in the broader society. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14356-6.

Loss of jobs/business/income; increased stress/distress, mental illness & speed of cognitive decline in the elderly with dementia in aged care.

Intended consequences
Decreased infections, deaths & health-system burden; flatten the curve Possible unintended consequences Increased stress & emergence of mental illness; increased noncommunicable disease (increased smoking, alcohol consumption, weight gain); increased job loss, poverty leading to economic recession; increased domestic violence & divorce; gender inequality; education inequities. Decreased risk; incidence, morbidity, mortality from seasonal flu & other communicable diseases; decreased environmental pollution.

Is a HIA appropriate? Why or Why not?
A desk-based EFHIA (Equity-focused health impact assessment) will help to explore the inequities emerging from lockdown COVID-19 suppression strategies/policies to inform and strengthen future pandemic preparedness plans.

Checklist summary
The policy directly & indirectly will potentially affect health. It is unclear what potentially serious negative impacts might result, but further investigation to elucidate this is warranted. As this is a fairly novel policy, the potential health impacts are not well known, but unlikely to be minor, so it may not be straightforward to suggest effective ways to maximise beneficial and minimise harmful effects.
The entire population of Victoria will be affected by the policy including all vulnerable, socially excluded & disadvantaged groups. There are community concerns about the impact of the policy.
The extent of the disruption to population is likely to be major with potentially high costs through various avenues.
Due to limited time & resources, & considering there is no potential to change the current policy, the use of a desk-based EFHIA can highlight need for a comprehensive EFHIA to advise policymakers & improve policy for future deployment.

Recommendations/comments
Proceed to desk-based EFHIA. No known HIA has been conducted on this proposal. Consider if there is a window of opportunity (ie. Timeliness, currency, political support). If the window is close, select the less comprehensive tool.

Capacity (in house)
What is the in-house level of expertise in HIA?
The higher the level of expertise, the more comprehensive the HIA should be.

Capacity (in house)
What level of staff resources and support are available?
The higher the resource and support level, the more comprehensive the HIA should be.

Capacity (external)
What level of expert support is available?
The higher the level of expert support, the more comprehensive the HIA should be.

Resources
What funds are available?
The higher the level of funding, the more comprehensive the HIA should be.

Resources
What data associated with the proposal is available and accessible? What is the health evidence base associated with the proposal?
If more data is available and accessible, the more comprehensive the HIA should be. Democracy With the goal of informing and influencing future directives, it is important to involve community members in directive reformulation. Democracy accentuates the right to participation in a transparent process of directive reformulation affecting lives and livelihoods (2). Equity

Supplementary
The goal of the public health direction should be to protect the health of the target population equitably. However, this involves accommodating for differences in the impact of the directive; eliminating factors which may be avoidable and unfair in terms of gender, age, ethnic background and socio-economic status resulting in inequities and furthering health inequalities (2). Sustainable Development In implementing the directive, short-term and long-term, direct and indirect impacts of the directive need to be considered. All-inclusive Protection Public health directions protecting population health should aim to protect all facets of health, including physical, and mental wellbeing adopting a comprehensive health for all focus.

Socially Just
Public health directives should seek to be socially just and equitable in their implementation and outcomes (2). Accountability Decision-makers should be accountable to the communities they serve (2).